Sickness certificates should be considered one of the most potentially dangerous treatments a general practitioner can offer a patient, a behavioural scientist says.

Dr Debra Dunstan of the University of New England in Armidale says an incorrectly issued sickness certificate can be the catalyst for a relatively well person ending up in long-term unemployment.

In a paper recently published in the Australian Family Physician journal, Dunstan points to an alarming rise in sickness certification with a 70% increase in requests during the past nine years.

She says the effect of long-term worklessness on health has been "equated with smoking 10 packets of cigarettes a day", she says.

It is also "said to have more impact on life expectancy than killer diseases such as cardiovascular illness and cancer".

While Dunstan says, "we're not talking head colds", she is concerned that people with common ailments such as musculoskeletal problems and mild to moderate mental health issues are receiving extended certified absences from work.

"The level of work disability attributed to commonly occurring conditions is on the rise," says Dunstan.

However, she points to studies that show people on certified sick leave will "commonly start down a slippery slope that leads to long-term worklessness".

By six months, a person on extended sick leave has only a 20% chance of being in the workforce in five years' time.

"Adults are meant to work," she says. "They get their social connectedness, a sense of identity and a sense of purpose from work."

When people become long-term unemployed they experience a general deterioration in their quality of life and physical and mental health.

They are also at an increased risk of suicide.

She says the "crisis" in Australia is being replicated in other western nations such as Canada, the UK and the United States.

"It is so paradoxical that this is happening as the congenitally disabled have fought so strongly to be able to work," she says.

For work-related mental health problems, such as stress and anxiety, absence from work is the wrong treatment, Dunstan says.

Tackling the problem

"What we know is something that causes anxiety or fear should not be avoided," she says, "rather people should be given the skills to get on top of the problem."

Dunstan says there needs to be a reduction in the number and length of sickness certificates and suggests the adoption of a model being used in some Canadian provinces where duration of work disability is determined by set, evidence-based guidelines.

However as a first step, she says GPs need to rethink the way in which they view sickness certificates.

"Sickness certificates should be issued with the same caution that applies to other treatments carrying significant health risks."